Purpose
Posterior ankle impingement is comprised of several etiologies,
broadly categorized as osseous or soft-tissue.
Soft-tissue causes involve injuries to the joint capsule,
posterior talofibular,
intermalleolar,
and tibiofibular ligaments with subsequent development of scar-tissue1.
Osseous structures involved in posterior ankle impingement include a prominent posterior process of the talus (stieda process),
an os trigonum,
post-traumatic calcification,
loose bodies,
or posterior tibio-talar osteophytes2. An os trigonum,
one of the most common osseous etiologies3,
is frequently an incidental finding in asymptomatic patients.
The initial approach to treatment of...
Methods and Materials
This retrospective study was approved by our hospital’s Institutional Review Board with a waiver of informed consent.
A search of our radiology department database was performed utilizing mPower (Nuance,
Burlington,
MA) using the search terms “os trigonum,” “posterior process of the talus,” “posterior talar neck,” and “stieda process”,
as well as filters for modality (ultrasound) and inclusion dates (January 1,
2015-June 30,
2018).
Exclusion criteria included diagnostic ultrasounds without an injection,
or US-guided injections targeted to the ankle joint,
subtalar joint,
posterior talofibular ligament,
or...
Results
A total of 102 injections were performed in 87 patients (47 female and 40 male) with an average age of 30 years and a range of 12 to 77 years. A 25 gauge needle was used in 95 of 102 cases,
a 27 gauge needle in 4 cases,
and a 22 gauge in 3 cases.
A combination of anesthetic and corticosteroid was used in 88 cases,
which consisted of lidocaine and either triamcinolone,
methylprednisolone,
or betamethasone.
In 14 cases lidocaine and bupivicaine was used for...
Conclusion
In conclusion,
ultrasound guided injections in patients with a symptomatic os trigonum or prominent posterior talar process is a safe procedure which is a useful diagnostic test for clinicians in deciding which patients will benefit from a surgical procedure.
In rare cases,
combined with physiotherapy,
an ultrasound guided injection may provide long term relief.
References
1.
Robinson P,
Bollen SR.
Posterior ankle impingement in professional soccer players: effectiveness of sonographically guided therapy.
AJR Am J Roentgenol.
2006 Jul;187(1):W53-58.
2. Niek van Dijk C.
Anterior and posterior ankle impingement.
Foot Ankle Clin.
2006 Sep;11(3):663–83.
3.
Maquirriain J.
Posterior ankle impingement syndrome.
J Am Acad Orthop Surg.
2005 Oct;13(6):365–71.
4.
Giannini S,
Buda R,
Mosca M,
Parma A,
Di Caprio F.
Posterior ankle impingement.
Foot Ankle Int.
2013 Mar;34(3):459–65.
5.
Sofka CM.
Posterior Ankle Impingement: Clarification and Confirmation of the Pathoanatomy.
HSS...
Personal Information
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Nicholas Vassos
Musculoskeletal Ultrasound Fellow
Department of Radiology and Imaging
Hospital for Special Surgery
Weill College of Medicine of Cornell University
New York,
New York
Theodore T.
Miller
Chief,
Division of Ultrasound
Department of Radiology and Imaging
Hospital for Special Surgery
Professor of Radiology
Weill College of Medicine of Cornell University
New York,
New York